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NED Cat. 2 – Voucher Issuance and Leasing Issuance and Leasing –All Category 2 vouchers must initially be leased by NED families transitioning from a nursing home or institution into the community –If the initial issuance does not result in a lease-up, the PHA must re-issue the HCV to another Category 2 family –All vouchers expected to be leased within one year of the ACC (~2/1/12) 7

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NED Cat. 2 – Turn Over Turn Over –All NED Category 2 “turn over” vouchers must be issued to another Category 2 family upon turn over if a Category 2 family is on the PHA’s waiting list –If there is no Cat. 2 family on the waiting list, the PHA must contact its partner agency and conduct outreach to identify potentially eligible individuals –Only after all means of outreach have been taken can the PHA re-issue the voucher to a NED family on the PHA’s waiting list that is not in a nursing home/institution –Any subsequent turn over of that voucher must again be used for a Cat. 2 family 8

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NED Cat. 2 – Waiting List Requirements Waiting List –All Cat. 2 families must be selected from the PHA HCV waiting list. Any PHA preferences apply when selecting among Cat. 2 families For example, some PHAs have a residency preference (for families that live or work in the PHA’s jurisdiction). Therefore, Cat. 2 families on the waiting list that qualify for this preference would be selected before Cat. 2 families that do not qualify for the preference. –PHAs without enough Cat. 2 eligible families on the current waiting list must open the list to accept referrals from partner agencies 9

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Eligible Participants & Documentation Non-Elderly and Disabled –Under 62 on the effective date of the first HAP contract executed by the PHA for the family Documentation of Social Security Number –Missing SSN card or birth certificate –HUD Notice PIH 2010-3 allows PHAs to use other documents issued by federal, state, or local government agencies that contain the SSN E.g., letter from state MFP agency, SSI award or benefit letter – as long as the document contains the SSN 10

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Eligible Participants & Documentation (2) Referred by partner agency that provides dedicated care and case management services –Can be any partner agency that provides these services, not just the agency identified in the application –The agency that provides services after transition is not required to be the agency that assists in the transition PHAs should have point of contact for ongoing collaboration Must be in an institution at the time that the voucher is issued to the family –Partner agency verifies that institution meets eligibility criteria and provides documentation to the PHA that identifies the institution where the individual lives at the time of the voucher 11

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Eligible Institutions Medicaid-Funded Institutions –Nursing Facilities (NF) –Intermediate Care Facilities for Mentally Retarded (ICF/MR) –Hospital –Institution for Mental Diseases (IMD) Non-Medicaid Funded Institutions –Private or public psychiatric facilities that have state- funded dedicated resources to transition NED families from the institution to the community E.g., state resources available under an Olmstead or Department of Justice (DOJ) settlement 12

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Ineligible Institutions Board and Care Facilities Adult Day Care Community-based congregate settings and residential services that are not an ICF/MR, IMD, or NF 13

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Income Eligibility All NED Cat. 2 applicants must met HCV income eligibility requirements Many individuals in nursing homes/institutions have limited income –Benefits often decreased during institutional stay PHAs should use current income to calculate tenant rent and then conduct an interim examination when the family’s income changes 14

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HUD: Reasonable Accommodation A change in rules, policies, practices, or services that may be necessary to provide a person with a disability an equal opportunity to obtain housing, and to use and enjoy her home –Request must be disability-related All NED Category 2 applicants are disabled and have complex and long-term health needs and may request reasonable accommodations –PHA and partner agency may want to develop systems to anticipate possible requests 15

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Examples of Reasonable Accommodations Housing Search –Cat. 2 families may need longer search times to find accessible units –60 day minimum. PHAs may approve a longer term (24 CFR 303(b)(2)) –The family may request a current listing of accessible units known to the PHA that may be available (24 CFR 982.301(b)(12)) 16

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Examples of Reasonable Accommodations (2) 26% of MFP transitions are to group homes and 26% to family’s home As a reasonable accommodation, PHAs are required to allow people with disabilities to: –Use vouchers in Special Housing Types (24 CFR 982.517) Group Homes Congregate Housing Shared Housing Homeownership –Rent a unit owned by a relative (parent, child, grandparent, grandchild, sister or brother) (24 CFR 306(d)) 17

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Examples of Reasonable Accommodations (3) Exception Payment Standards (24 CFR 982.503(c)(2)(ii))) –A PHA may approve a payment standard up to 110% of the Fair Market Rent (FMR) as a reasonable accommodation after a unit has been located –HUD Field Office may approve a payment standard above 110% to 120% FMR –HUD Headquarters may approve a payment standard above 120% FMR Exception Utility Allowance (24 CFR 982.517) –A PHA must approve a higher utility allowance if requested as a reasonable accommodation Example: a family member uses extensive medical equipment 18

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Examples of Reasonable Accommodations (4) Live-in Aides (24 CFR 982.316) –PHA must approve a live-in aide if needed as a reasonable accommodation to make the program accessible to and usable by a person with a disability –PHAs can screen live-in aides for criminal and housing history –Must prove that the person would not be living there except to provide the necessary supportive services Exceptions to Subsidy Standards (24 CFR 982.402(b)(8)) –Family circumstances may warrant the provision of an additional bedroom to permit disability-related overnight care and allow the family equal use and enjoyment of the unit –Accommodate newer service models that have rotating caregivers that don’t qualify as live-in aides –Accommodate large medical equipment 19

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Portability Cat. 2 HCV families can exercise portability Portability allows all HCV families to use their voucher to lease a unit in another community (as long as there is a PHA HCV program there) A new HCV family that resided outside of the PHA’s jurisdiction at the time the family first applied for assistance, does not have the right to portability for the first 12 months following admission. However, the initial PHA may choose to allow portability during this period. –As a reasonable accommodation, a person with a disability can request that this waiting period be waived, prior to signing a lease, if the portability relates to the persons disability 21

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Portability and Services If the partnering service agency determines that there are limits to services that will be provided in the area where the family wishes to move that would put the family at risk of losing their housing, the partnering service agency and family should review the risks and ways of mitigating them 22

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Opportunities for the State Medicaid Agency to Team With PHAs in the Category 2 Voucher Program 23

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Roles of the State Medicaid Agency Work with PHAs and Transition Coordination agencies to streamline referral processes Ensure Transition Coordination agencies are familiar with PHA forms and timelines Facilitate ongoing communication and problem solving between Transition Coordination agencies and their local PHAs Work with PHAs to identify alternative forms of verification of SSN and other information that can be provided by the State Involve Medicaid Operating Agencies participating in MFP in carrying out all of these roles 24

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25 Partner Agency Referral Process Outreach –Market/Educate NED Cat 2 opportunity to consumers, families, and social workers/other staff in nursing homes/institutions: Independent/integrated community housing in homes/neighborhood of choice; affordable to persons on SSI income; access to housing search and leasing assistance; access to assistance with overcoming housing barriers –Continuous outreach in nursing homes/institutions ensure on-going referrals –It may take 2 referrals for every successful voucher utilization –PHAs and partner agencies are encouraged to track referrals and establish the number of referrals needed to meet 100% lease-up by 2/1/12